Physical Health Comorbidities Research Articles

Care trajectories of individuals with anxiety disorders: A retrospective cohort study

BackgroundAnxiety disorders (ADs) are associated with increased healthcare use (HCU), and individuals may seek healthcare through various pathways according to clinical and individual characteristics. This study aimed to characterize care trajectories (CTs) of individuals with ADs. MethodsThis is a retrospective cohort study using the Care Trajectories - Enriched Data cohort, a linkage between the Canadian Community Health Surveys (CCHS), and health administrative data from Quebec. The cohort included 5143 respondents reporting ADs to the CCHS between 2009 and 2016. We measured CTs over 5 years before CCHS using a state sequence analysis. ResultsThe cohort was categorized into five types of CTs. Type 1 (52.7 %) was the lowest care-seeking group, with fewer comorbidities. Type 2 (24.0 %) had higher levels of physical and mental health comorbidities and moderate HCU, mainly ambulatory visits to general practitioners. Type 3 (13.1 %) represented older patients with the highest level of physical illnesses and high HCU, predominantly ambulatory consultation of specialists other than psychiatrists. Types 4 and 5 combined young and middle-aged patients suffering from severe psychological distress. HCU of type 4 (6.7 %) was high, mainly consultations of ambulatory psychiatrists, and HCU of type 5 (3.5 %), was the highest and mostly in acute care. LimitationsAdministrative and survey data may have coding errors, missing data and self-report biases. ConclusionFive types of CTs showed distinct patterns of HCU often modulated by physical and mental health comorbidities, which emphasizes the importance of considering ADs when individuals seek care for other mental health conditions or physical illness.

Associations Between Head Injury, Strangulation, Cardiometabolic Health, and Functional Disability Among Female Survivors of Intimate Partner Violence

ObjectiveHead injury and strangulation are highly prevalent in intimate partner violence (IPV) contexts, but there is little research examining the potential implications of these injuries on physical health and functional status. This pilot study explored the extent to which injury type (head injury, strangulation) and severity (no injury, subconcussive head injury, traumatic brain injury; no strangulation, strangulation, strangulation with loss of consciousness) were associated with biomarkers of cardiometabolic health and self-reported functioning among female survivors of IPV. MethodsParticipants were 51 individuals assigned female at birth who experienced IPV during their lifetime and screened positive for probable posttraumatic stress disorder (PTSD) on the PTSD Checklist for DSM-5 (average age = 32.6 years, SD = 7.1). ResultsHead injury was associated with statistically significant increases in blood glucose levels (p = .01, d = 1.10). Shifts toward more high-risk values with moderate-strong effect sizes were also found in high-density lipoprotein, low-density lipoprotein, and waist-to-hip ratio (ps: .06–.13; ds: 0.51–1.30). Strangulation was associated with increased cholesterol levels, with a moderate effect size (p = .20, d = 0.59). Regression models accounting for age, education, PTSD symptoms, childhood trauma, strangulation, and head injuries predicted functional disability status (R2 = 0.37, p < .01) and several of its associated domains: cognition (R2 = 0.34, F(8,42) = 2.73, p = .01), mobility (R2 = 0.47, F(8,42) = 4.82, p < .001), and participation in society (R2 = 0.33, F(8,42) = 2.59, p = .02). ConclusionsFindings suggest the need to develop integrated treatments that address physical health comorbidities among female survivors of IPV with a history of head injury to improve daily function and quality of life.

The short-, medium-, and long-term prevalence of physical health comorbidities in first-episode psychosis: a systematic review protocol

Background Individuals with first-episode psychosis (FEP) face an increased risk of physical comorbidities, notably cardiovascular diseases, metabolic disorders, respiratory disorders, and certain types of cancer. Previous reviews report pooled physical health prevalence from chronic psychosis and FEP groups. By contrast, this review will focus on antipsychotic-naïve FEP cohorts and incorporate data from observational longitudinal studies and antipsychotic intervention studies to understand the progression of physical health comorbidities from the onset to later stages of psychosis. This review aims to systematically examine the short-, medium-, and long-term period prevalence of these comorbidities in FEP and variations related to demographic factors. Methods A systematic review will be conducted using the PRISMA and MOOSE guidelines. Medline, Embase, PsycINFO, and CINAHL+, as well as Clinical Trials gov.uk, OpenGrey, WHO International Clinical Trials Registry Platform, Current Controlled Trials, United States National Institute of Health Trials Registry, and the Irish Health Repository, will be searched from inception. Longitudinal studies exploring physical health outcomes in FEP cohorts and antipsychotic intervention studies monitoring health outcomes in antipsychotic naïve FEP individuals will be eligible for inclusion. Two reviewers will independently screen titles, abstracts, and full-text articles. Bias in individual studies will be assessed using the JBI Critical Appraisal Checklist. A meta-analysis of the short-, medium-, and long-term prevalence of cardiovascular, metabolic, cancer, and respiratory outcomes and a narrative synthesis will be conducted. If possible, a meta-regression on the impact of demographic variables will be conducted. Conclusions This systematic review will clarify the progression of physical health comorbidities in FEP, informing early intervention strategies and policies for this population. Subsequent findings will be submitted to a leading journal, supplemented by a recovery education module for patient groups and a lay summary for wider dissemination. Registration The study was registered in PROSPERO, the International Prospective Register of Systematic Reviews (CRD42023431072; 17/06/2023).

Associations between Rheumatoid Arthritis and Various Comorbid Conditions in Germany—A Retrospective Cohort Study

Aims: The aim of the present study was to estimate the prevalence of physical and mental health comorbidities in patients with rheumatoid arthritis (RA) in Germany, in order to better understand the complex clinical picture and its consequences. Methods: This retrospective cohort study was based on data from the IQVIA Disease Analyzer database and included individuals aged ≥ 16 years with an initial documented diagnosis of RA between 2015 and 2021 (index date). RA patients were matched 1:1 with non-RA individuals using nearest neighbor propensity score matching. The study investigated associations between RA and various disorders documented within 365 days after the index date. The cumulative incidence of defined disorders was calculated for individuals with and without RA. Multivariable logistic regression models were used to study these associations. Results: Data were available for a total of 49,713 patients with and 49,713 patients without RA (mean age: 60.4 (SD: 15.5) years; 66.7% female). A significant and clinically relevant positive association was observed between RA and seven disorders: soft tissue disorders (Odds Ratio (OR): 1.47; 95% Confidence Interval (CI): 1.42–1.52), renal failure (OR: 1.36; 95% CI: 1.26–1.47), anemia (OR: 1.32; 95% CI: 1.24–1.40), liver diseases (OR: 1.32, 95% CI: 1.23–1.41), osteopathies and chondropathies (OR: 1.28; 95% CI: 1.22–1.3), diseases of the esophagus, stomach and duodenum (OR: 1.18; 95% CI: 1.14–1.22), and nutritional deficiencies (OR: 1.17; 95% CI: 1.10–1.24). Conclusions: We observed significant associations between RA and several comorbidities, which have clinical relevance for the care of RA patients not only in general practices but also in specialist settings.

Prevalence of physical health comorbidities and long-term functional outcomes among community-reintegrated veterans following lower limb amputation in Sri Lanka

IntroductionLower limb amputation (LLA) poses significant health challenges, including physical health comorbidities (PHCs) and functional limitations. Military veterans, who typically undergo traumatic LLA at a young age, endure these challenges...

Sex Differences Among Older Adults With Bipolar Disorder: Results From the Global Aging & Geriatric Experiments in Bipolar Disorder (GAGE-BD) Project

ObjectiveSex-specific research in adult bipolar disorder (BD) is sparse and even more so among those with older age bipolar disorder (OABD). Knowledge about sex differences across the bipolar lifespan is urgently needed to target and improve treatment. To address this gap, the current study examined sex differences in the domains of clinical presentation, general functioning, and mood symptoms among individuals with OABD. MethodsThis Global Aging & Geriatric Experiments in Bipolar Disorder (GAGE-BD) study used data from 19 international studies including BD patients aged ≥50 years (N = 1,185: 645 women, 540 men).A comparison of mood symptoms between women and men was conducted initially using two-tailed t tests and then accounting for systematic differences between the contributing cohorts by performing generalized linear mixed models (GLMMs). Associations between sex and other clinical characteristics were examined using GLMM including: age, BD subtype, rapid cycling, psychiatric hospitalization, lifetime psychiatric comorbidity, and physical health comorbidity, with study cohort as a random intercept. ResultsRegarding depressive mood symptoms, women had higher scores on anxiety and hypochondriasis items. Female sex was associated with more psychiatric hospitalizations and male sex with lifetime substance abuse disorders. ConclusionOur findings show important clinical sex differences and provide support that older age women experience a more severe course of BD, with higher rates of psychiatric hospitalization. The reasons for this may be biological, psychological, or social. These differences as well as underlying mechanisms should be a focus for healthcare professionals and need to be studied further.

The Relationship between Lifetime Opioid Use and Mental and Physical Health among Incarcerated Individuals

Abstract Relationships between opioid use and health, both physical and mental, have been discovered over the last decade or so, but these relationships have yet to be explored among incarcerated individuals. These relationships are important as they may have implications on the health of those who are incarcerated and nearing reentry, because higher rates of opioid use, as well as poor physical and mental health, are found among those who are justice-involved compared with the general population. Using baseline data from a multistate randomized controlled trial, authors aimed to fill this gap by exploring mental health disorder rates and physical health among a sample of incarcerated individuals who report lifetime opioid use and nearing community reentry. Results showed that the prevalence of lifetime opioid use was significantly associated with increased physical role limitation, decreased emotional well-being, and overall poorer health. Additionally, individuals with a lifetime history of opioid use were significantly more likely to have depression, social and generalized anxiety disorders, as well as a history of alcohol and illicit substance use. This work speaks to the urgency in expanding efforts to increase access to comprehensive service delivery models that address substance use, mental health, and physical health comorbidities among incarcerated individuals.

Increased rates of chronic physical health conditions across all organ systems in autistic adolescents and adults

BackgroundThe poorer physical health of autistic adults compared to non-autistic adults has been highlighted by several epidemiological studies. However, research has so far been limited to specific geographical areas and has primarily focused on young autistic individuals (aged 35 years and younger). Recent studies indicate a higher rate of mortality in autistic people, as well as poorer quality of self-reported healthcare interactions. This study aims to determine, first, whether autistic people experience greater levels of non-communicable health conditions and second, whether these are explained by differences in demographics (i.e. sex, country of residence, ethnicity, education level), alcohol use, smoking, body mass index (BMI), or family history of medical conditions.MethodWe employed a cross-sectional, convenience-sampling study via an anonymous, online survey of autistic and non-autistic adults (n = 2305, mean age = 41.6, 65.9% female, 49% autistic). The survey asked participants to self-report information about their demographics, autism diagnosis, diet, exercise, sleep, sexual health, substance use, personal medical history, and family medical history (for all first-degree, biological relatives). Binomial logistic regression across four iterative models of increasing complexity was applied to assess rates of physical health conditions. The Benjamini–Hochberg correction was used to account for multiple testing, and only physical health conditions that achieved at least 1% endorsement within the overall sample (n > 22) were included in the analysis to reduce risk of Type I errors. We also used novel network analysis methods to test whether there are increased levels of multimorbidity between autistic and non-autistic people.ResultsThere were significantly elevated rates of non-communicable conditions across all organ systems in autistic people, including gastrointestinal, neurological, endocrine, visual, ear/nose/throat, skin, liver and kidney, and haematological conditions. We confirmed previous findings by showing highly significant differences in rates of neurological and gastrointestinal symptoms (p < 0.0001). In addition, we established in the largest sample to date that Ehler-Danlos Syndrome (EDS) was more likely to occur among autistic females compared to non-autistic females. Finally, we found a higher prevalence of Coeliac’s disease among autistic individuals compared to non-autistic individuals after controlling for sex, ethnicity, country of residence, alcohol use, smoking, and BMI, but these results became non-significant after accounting for family history.LimitationsOur study is biased towards females, white individuals, highly educated people, and UK residents, likely due to sampling biases. Our self-report study design may also exclude those who lack access to computers, or those with intellectual disability. Our network analysis is also limited in size.ConclusionsThis study provides evidence of widespread, physical health comorbidity that spans nearly all major organ systems in autistic adults compared to non-autistic adults, using both binary logistic regression and network models. Healthcare professionals must be made aware of the range of co-occurring physical health conditions that may be more common among autistic people. However, our findings also point towards potential avenues requiring further exploration, such as the association of autism with both Coeliac’s disease and EDS.

Service user experiences of a physical health group for people experiencing psychosis, designed following service user consultation

Psychosis is associated with physical health comorbidities. Exercise and a healthy diet can improve cardiometabolic risk and mental wellbeing. This study explores the feasibility, acceptability, and experiences of a physical health group for clients experiencing psychosis. The group was developed and refined following consultation with service-users and culturally appropriate peer support workers. It included eight weekly sessions. The aims of the group were to provide psychoeducation on healthy living and to build motivation to engage in healthy living. Attendance, completion, and satisfaction were recorded to determine feasibility and acceptability of local service delivery. Clients took part in follow-up qualitative interviews to understand experiences of attending the group. Interviews were analysed using thematic analysis. Twenty-five clients were referred to the group. Overall, 10 clients enrolled in the group. Clients who enrolled in the group attended a median of 4.5 sessions. The mean satisfaction score for all sessions combined was 9.15/10 [SD 1.18]. Seven individual interviews were conducted. Two themes emerged. 1) Positive views towards the group, with clients feeling more aware of the benefits of healthy living, and clients finding the group setting motivating. 2) Considerations when planning healthy living support, which reflected subthemes in difficulties maintaining healthy living and concerns that the group should not be about weight loss. Investigations were limited to one mental health provider. It was feasible and acceptable to implement a healthy living group for clients with psychosis in a community mental health team, and this intervention was met with positivity.

Obstacles to treatment retention in opioid use disorder: An international substance use disorder treatment worker survey.

Treatment retention is associated with better outcomes and reduced risk amongst people experiencing opioid use disorder (OUD). Despite this, treatment retention remains low amongst this population. We carried out an international cross-sectional survey of substance use disorder (SUD) treatment service workers. We aimed to understand the barriers to treatment retention in the context of OUD from the provider perspective, identify differences in response preference between professional groups, and describe regional differences in treatment provision. We report data from 497 respondents based in the USA and the UK. Personality disorders, low motivation to change and social problems were the most often reported obstacles to retention. Comorbid SUD, hepatitis and HIV were not reported as often as expected. We identified associations between professional groups and response preferences related to comorbid SUD, low motivation, living arrangements and communication difficulties. UK respondents used behavioural treatments more than their US counterparts. US respondents more often reported using objective methods of measuring retention such as urine analysis, compared to their UK counterparts. The findings from this survey suggest that regional differences exist between US and UK based SUD treatment service workers. Personality disorders represented the most often experienced obstacles to treatment retention amongst patients with OUD, with mental health and social problems more often reported than comorbid drug problems or physical health problems. Statistically significant relationships exist between professional group and obstacles reported. These data may be used to identify additional training needs amongst SUD treatment service staff.

Mental Health program integration into Primary Health Care: Results of a Project Implemented at Yarmouk Health Care Center &amp; Capital Health Primary Care Center, Kuwait

Objective: World Health Organization (WHO) identified a gap in meeting mental health care needs in the health services. To bridge this gap, at Yarmouk Primary Health Care Center and Capital Health District area in Kuwait, it was decided to implement a best practice model, for integrating mental health services into primary health care services in Kuwait. Methodology: Implementation of the best practice model, for integrating mental health services into primary care services in Kuwait’s health system was initiated in 2008. It involved the integration of cost–effective, feasible evidence-based interventions for mental health conditions in Primary Health Care (PHC) and other priority health programs. It envisioned a mental health component in PHC, to enhance access to mental health care and improve identification and treatment rates for priority mental disorders, to provide holistic care for particularly disabling comorbid physical and mental health problems, and to engage in mental health promotion. Results: The program was initiated in 12 primary mental health care clinics in the Capital Health District area in Kuwait. Two hundred (200) Family Physicians and General Practitioners, were trained in psychiatric integration within the primary health care system. Regular evaluation of the performance of physicians working in primary mental health clinics in the program was ensured. Periodic evaluation of psychiatric patient visits in the Primary mental health clinics was conducted for quality improvement. Mental health awareness days and educational sessions were organized. Discussion: A practice model for integrating mental health services into primary care was developed in Kuwait, involving stakeholders. Its favorable impact on mental health in the community is undergoing scrutiny. Limitations such as human resource shortage and, movement of trained physicians from primary care to other administrative departments in the Ministry of Health (MOH), coupled with a lack of relevant data and the need for better coordination between stakeholders, were identified. Issues regarding electronic health records, patient confidentiality, and quality of services were identified. Stigma related to mental health issues resulted in a delay in implementing the integration. Conclusion: With increasing psychiatric illnesses and a lack of adequate specialized mental health services, addressing this issue at the primary care level offers an attractive cost-effective option to deal with the crisis. Keywords: Mental Health, Primary Health Care, Integration, Health system, Family Physician

Sleep problems in children and adolescents in an attention deficit hyperactivity disorder service.

Sleep problems are common amongst children and adolescents with attention deficit hyperactivity disorder (ADHD). The purpose of this study was to investigate sleep problems in children and adolescents attending a specialist ADHD service. This was a cross-sectional online survey combined with a retrospective chart review, conducted in the ADHD Assessment, Diagnosis, Management, initiation, Research and Education (ADMiRE) service, the first public specialist ADHD service for young people in Ireland. Participants were caregivers of children and adolescents with ADHD attending ADMiRE. Sleep was assessed using The Children's Sleep Habits Questionnaire (CSHQ) and ADHD symptoms were assessed using an abbreviated version of the Swanson, Nolan and Pelham Teacher and Parent Rating Scale (SNAP-IV). Details regarding patient demographics, co-morbidities and medication were collected from patient records. Eighty-four percent of young people scored above the clinical cut-off for a sleep disorder. The most frequently reported sleep problems were related to sleep onset and sleep duration, and 64% of respondents met the criteria for two or more sleep problems. ADHD severity was associated with greater sleep problems. Co-morbid physical, neurodevelopmental, and mental health disorders as well as stimulant use were not associated with greater sleep problems. Sleep problems are very common amongst children and adolescents with ADHD. This study has demonstrated an association between more sleep problems and ADHD severity. These findings highlight the need for both effective ADHD treatment to ensure optional sleep in young people as well as effective interventions for sleep problems to prevent worsening of ADHD symptoms.

Het gesprek over gezondheid met mensen met een autismespectrumstoornis: Wat is daar voor nodig?

Het gesprek over gezondheid met mensen met een autismespectrumstoornis: Wat is daar voor nodig?

Factors associated with psychiatric and physical comorbidities in bipolar disorder: a nationwide multicenter cross-sectional observational study.

Bipolar disorder (BD) is a chronic and disabling affective disorder with significant morbidity and mortality. Despite the high rate of psychiatric and physical health comorbidity, little is known about the complex interrelationships between clinical features of bipolar illness and comorbid conditions. The present study sought to examine, quantify and characterize the cross-sectional associations of psychiatric and physical comorbidities with selected demographic and clinical characteristics of adults with BD. A nationwide multicenter cross-sectional observational epidemiological study conducted from October 2015 to March 2017 in Slovakia. Out of 179 study participants [median age 49 years (interquartile range IQR 38-58); 57.5% females], 22.4% were free of comorbidity, 42.5% had both psychiatric and physical comorbidities, 53.6% at least one psychiatric comorbidity, and 66.5% at least one physical comorbidity. The most prevalent were the essential hypertension (33.5%), various psychoactive substance-related disorders (21.2%), specific personality disorders (14.6%), obesity (14.5%), and disorders of lipoprotein metabolism (14%). The presence of an at least one physical comorbidity, atypical symptoms of BD, and unemployed status were each associated with an at least one psychiatric comorbidity independent of sex, early onset of BD (age of onset <35 years), BD duration and pattern of BD illness progression (p < 0.001). The presence of various psychoactive substance-related disorders, BD duration, atypical symptoms of BD, unemployed status, pension, female sex, and not using antipsychotics were each associated with an at least one physical comorbidity independent of the pattern of BD illness progression (p < 0.001). In several other multiple regression models, the use of antipsychotics (in particular, olanzapine) was associated with a decreased probability of the essential hypertension and predicted the clinical phenotype of comorbidity-free BD (p < 0.05). This cross-national study has reported novel estimates and clinical correlates related to both the comorbidity-free phenotype and the factors associated with psychiatric and physical comorbidities in adults with BD in Slovakia. The findings provide new insights into understanding of the clinical presentation of BD that can inform clinical practice and further research to continue to investigate potential mechanisms of BD adverse outcomes and disease complications onset.

The tertiary service for psychosis: Holistic recommendations for people with complex psychosis.

To describe (i) the clinical characteristics of individuals referred to the Tertiary Referral Service for Psychosis (TRSP) and (ii) the recommendations TRSP made for future treatment across psychopharmacological and other intervention domains. Retrospective audit of clinical data collected during the assessment process of individuals who accessed TRSP between 02/06/2020 and 31/12/2022. Categories of recommendations made following collaborative care planning comprised psychopharmacological, neuropsychological, psychological, psychosocial, physical health, substance misuse and other domains. Eighty-two individuals were included, with diagnoses most commonly of schizophrenia (54.9%) and schizoaffective disorder (30.5%). The median PANSS score was 88.0 (73-100). Social occupational functioning was very poor (SOFAS M = 37.0, SD = 15.1). Cognitive functioning was poor (RBANS: M = 74.6; SD: 15.0). 67.1% had physical health comorbidities, with high prevalence of smoking (52.4%) and substance misuse (25.6%). Psychopharmacological recommendations (made for 81.7%) included clozapine trial (25.6%), clozapine dose change/augmentation (22.0%) and rationalisation of polypharmacy (12.2%). Neuropsychological (73.2%), psychological (39.0%) and psychosocial (85.4%) recommendations included access to cognitive remediation, psychological therapy and disability support. Physical health and substance misuse interventions were recommended for 91.5% and 20.7%, respectively. Individuals referred to the TRSP had marked clinical and functional impairments. Holistic collaborative care planning complemented psychopharmacological interventions with psychological, psychosocial and physical healthcare recommendations.

Lifestyle interventions in comorbid mental and physical illness: A systematic review protocol.

Patients with mental health disorders (MHDs) often present with chronic illness and complain of pain and poor physical health. They present with a high burden of disease and poor quality of life. Significant associations between MHDs and chronic illness have been found. Lifestyle interventions are cost-effective strategies, which seem to be effective in managing comorbid mental and physical health disorders. Therefore, a summary of the evidence and clinical practice guidelines is needed in South Africa. Our study will aim to determine the effectiveness of lifestyle interventions on health-related quality of life, in patients with comorbid mental and physical health disorders. The systematic review will be conducted using the Joanna Briggs Institute (JBI) methodology for systematic reviews of effectiveness. MEDLINE (Ovid), CINAHL (EBSCO), LiLACS, Scopus, Physiotherapy Evidence Data Base (PEDro) and Cochrane Central Register of Controlled Trials will be searched. A three-step search strategy will identify published literature in all languages from 2011 to 2022. Critical appraisal of all included studies will be performed, and the relevant data will then be extracted. Where possible, data will be pooled in a statistical meta-analysis. The results will provide the best available evidence regarding lifestyle interventions in the management of patients with comorbid mental and physical health disorders. Our review will provide evidence on the effectiveness of lifestyle interventions in the management of patients with comorbid mental and physical health disorders. The results may assist in determining the best use of lifestyle interventions in the management of patients with MHDs and comorbidities.

Predictors of self-harm and emergency department attendance for self-harm in deprived communities

Emergency departments (EDs) are often the first point of contact for individuals following self-harm. The majority of previous research relies on hospital-based data, yet only a minority of individuals who self-harm in the community present to healthcare services. The study design is cross-sectional survey design. Data from the National Institute for Health Research Applied Research Collaboration North West Coast (NIHR ARC NWC) Household Health Survey, a community-based public health survey in North West England, was collected using stratified random sampling. Three thousand four hundred twelve people were recruited in 2018 from relatively disadvantaged areas. The sample included 1490 men and 1922 women aged 18 to 100 years (M = 49.37, SD = 18.91). Logistic regression analysis was employed to examine demographic, health and socioeconomic predictors of self-harm and ED attendance for self-harm. Age (18–24 years), lower financial status, depression, anxiety and physical and mental health co-morbidity was associated with significantly higher levels of self-harm. People aged 18–24 years, with physical and mental health co-morbidity and lower levels of social support had significantly higher levels of attending EDs for self-harm. Improving people’s financial situations, social connectivity, mental and physical health may help to reduce individual risk for self-harm and strain on health services.

Abstract 3010: Epigenetic age acceleration in older adults with hematologic malignancies

Abstract Background: Older adults with hematologic malignancy (HM) are a growing demographic with heterogenous health needs. Chronologic age, performance status and comorbidities impact the selection and intensity of treatments but may not accurately predict treatment toxicity or resiliency. Here, we conducted longitudinal measures of clinical frailty and epigenetic age to explore the relationships between physiologic aging and fitness. Methods: Newly diagnosed patients &amp;gt;60 years with HM were enrolled in a prospective longitudinal study with biomarkers procured at baseline (pre-therapy) and end-of-study (EOS). EOS was defined as the earliest of the following events: progression, transplant, or 1-year from baseline. Peripheral blood was collected, CD3+ T-cells isolated, and DNA extracted using a column-based commercial nucleic acid kit. Peripheral blood T lymphocytes samples were also procured from healthy controls using identical methods. PBTL was extracted, bisulfite converted, and methylation was quantified using the Illumina 850K EPIC methylation array at the TruDiagnostic core laboratory. Raw data was processed using the minfi pipeline, followed by normalization, batch correction, and KNN-based imputation using the GMQN and impute R packages. Principal-component (PC) PhenoAge measures were calculated using the processed methylation values. Measured clinical phenotypes of fitness included ECOG, independent activities of daily living, physical health scores, comorbidities, cognition (BOMC) and objective measures of function (SPPB). Results: 94 patients with HM (acute leukemia n=35, lymphoma n=23, CLL = 6, plasma cell n=30) with PBTL and clinical fitness data were evaluated. The median chronologic age was 70.55 years (range 28.71 yrs, IQR = 10.84). mPhenoAge was higher in patients with HM (Median = 49.59 yrs, Range = 71.245, IQR = 12.52) than healthy donors (Median = 30.46; Range = 75.58, IQR = 32.83). Patients with acute leukemia had the highest mPhenoAge (57.10 yrs, Range = 61.97, IQR = 30.03; p=3e-04). mPhenoage was lower in patients with ECOG 0 vs ECOG 1 (p=0.011). Patients with Acute leukemia also showed a decrease in mPhenoage at EOS (p=0.034), which was not seen in other HMs. Patient IADLs (p=0.032) and comorbidities (p=0.009) were positively correlated with Epigenetic Age Acceleration (EAA). Patient cognitive score (p=0.053) negatively correlated with EAA. mPhenoAge decreased more in patients who received hypomethylating therapies than those who received high-dose multi-drug chemotherapy, low-dose multi-drug chemotherapy or targeted agents. Conclusions: Physiologic age, as measured by PBTL mPhenoAge, is increased among older adults with HMs relative to healthy controls. PBTL mPhenoAge is highest among HM patients with acute leukemia and changes are associated with clinical phenotypes. PBTL mPhenoAGE decreased with hypomethylating agents in patients with acute leukemia. Citation Format: Ashley E. Rosko, Kaitlyn Dvorak, Jennifer Woyach, Varun Dwaraka, Ryan Smith, Ryann Finlayson, Alice Mims, Christin Burd. Epigenetic age acceleration in older adults with hematologic malignancies [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 3010.

Association of severe mental illness and septic shock case fatality rate in patients admitted to the intensive care unit: A national population-based cohort study.

Patients with severe mental illness (SMI) (i.e., schizophrenia, bipolar disorder, or major depressive disorder) have been reported to have excess mortality rates from infection compared to patients without SMI, but whether SMI is associated with higher or lower case fatality rates (CFRs) among infected patients remains unclear. The primary objective was to compare the 90-day CFR in septic shock patients with and without SMI admitted to the intensive care unit (ICU), after adjusting for social disadvantage and physical health comorbidity. We conducted a nationwide, population-based cohort study of all adult patients with septic shock admitted to the ICU in France between January 1, 2014, and December 31, 2018, using the French national hospital database. We matched (within hospitals) in a ratio of 1:up to 4 patients with and without SMI (matched-controls) for age (5 years range), sex, degree of social deprivation, and year of hospitalization. Cox regression models were conducted with adjustment for smoking, alcohol and other substance addiction, overweight or obesity, Charlson comorbidity index, presence of trauma, surgical intervention, Simplified Acute Physiology Score II score, organ failures, source of hospital admission (home, transfer from other hospital ward), and the length of time between hospital admission and ICU admission. The primary outcome was 90-day CFR. Secondary outcomes were 30- and 365-day CFRs, and clinical profiles of patients. A total of 187,587 adult patients with septic shock admitted to the ICU were identified, including 3,812 with schizophrenia, 2,258 with bipolar disorder, and 5,246 with major depressive disorder. Compared to matched controls, the 90-day CFR was significantly lower in patients with schizophrenia (1,052/3,269 = 32.2% versus 5,000/10,894 = 45.5%; adjusted hazard ratio (aHR) = 0.70, 95% confidence interval (CI) 0.65,0.75, p < 0.001), bipolar disorder (632/1,923 = 32.9% versus 2,854/6,303 = 45.3%; aHR = 0.70, 95% CI = 0.63,0.76, p < 0.001), and major depressive disorder (1,834/4,432 = 41.4% versus 6,798/14,452 = 47.1%; aHR = 0.85, 95% CI = 0.81,0.90, p < 0.001). Study limitations include inability to capture deaths occurring outside hospital, lack of data on processes of care, and problems associated with missing data and miscoding in medico-administrative databases. Our findings suggest that, after adjusting for social disadvantage and physical health comorbidity, there are improved septic shock outcome in patients with SMI compared to patients without. This finding may be the result of different immunological profiles and exposures to psychotropic medications, which should be further explored.

Framing substance use disorders among forcibly displaced people through a syndemics lens.

AbstractSyndemics are synergistically interacting epidemics (for example, the epidemics of substance use disorders and forced displacement) in a particular context with shared drivers such as pre-existing political, structural, social and health conditions. Policymakers may ask what the risks of and needs are for forcibly displaced people with regards to substance use disorder (SUD). Working from a syndemics framework, we would argue that multiple risk and resiliency factors relating to both forced displacement and SUD work synergistically, and impact more significantly upon some populations than others. These risk factors include structural inequality and racism, social deprivation, violence, homelessness, trauma, childhood adversity, and co-morbid physical and mental health disorders. Individuals may become vulnerable while experiencing displacement, during transition, settlement or resettlement, and also through their life across and across generations. In this perspective, our answers to policymakers becomes more nuanced. We may argue for integrated, multi-modal interventions, cross-disciplinary collaborations, cross-pollination of ideas and knowledge and embedding lived experience to bridge gaps and make use of limited resources in sustainable ways. This presentation will detail aspects of the application of a syndemic lens to the evidence base on SUD among forcibly displaced people and generate discussion on what scientists, clinicians and policymakers can and may do with these insights.Disclosure of InterestNone Declared